Healthcare Provider Details

I. General information

NPI: 1295377828
Provider Name (Legal Business Name): KRISCHELL SCARLETH BRAND MA73471
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2791 LAKE ALFRED RD
WINTER HAVEN FL
33881-1432
US

IV. Provider business mailing address

414 8TH ST S
DUNDEE FL
33838-4336
US

V. Phone/Fax

Practice location:
  • Phone: 863-291-4590
  • Fax:
Mailing address:
  • Phone: 863-668-1397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA73471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: